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PubMedDate not supplied

Cardiac resynchronization therapy (CRT) in heart failure--a model to assess the economic value of this new medical technology.

OBJECTIVES: This article describes the framework of a comprehensive European model developed to assess clinical and economic outcomes of cardiac resynchronization therapy (CRT) versus optimal pharmacological therapy (OPT) alone in patients with heart failure. METHODS: The model structure is based on information obtained from the literature, expert opinion, and a European CRT Steering Committee. The decision-analysis tool allows a consideration of direct medical and indirect costs, and computes outcomes for distinctive periods of time up to 5 years. Qualitative data can also be entered for cost-utility analysis. Model input data for a preliminary economic appraisal of the economic value of CRT in Germany were obtained from clinical trials, experts, health statistics, and medical tariff lists. RESULTS: The model offers comprehensive analysis capabilities and high flexibility so that it can easily be adapted to any European country or special setting. The illustrative analysis for Germany indicates that CRT is a cost-effective intervention. Although CRT is associated with average direct medical net costs of Euro 5880 per patient, this finding means that 22% of its upfront implantation cost is recouped already within 1 year because of significantly decreased hospitalizations. With 36,600 Euros the incremental cost per quality-adjusted life-year (QALY) gained is below the euro equivalent (41,300 Euros, 1 Euro = US1.21 dollars) of the commonly used threshold level of US50,000 dollars considered to represent cost-effectiveness. The sensitivity analysis showed these preliminary results to be fairly robust towards changes in key assumptions. CONCLUSIONS: The European CRT model is an important tool to assess the economic value of CRT in patients with moderate to severe heart failure. In the light of the planned introduction of Diagnosis Related Group (DRG) based reimbursement in various European countries, the economic data generated by the model can play an important role in the decision-making process.

Cardiac Pacing, Artificial↗
PubMed1996

Community development: theoretical and practical issues for community health nursing in Canada.

Despite the importance currently given to community development as an increasingly significant role for community nurses, there is little analysis of the role in the nursing literature. This paper provides background information on the historical origins of community development work through an extensive review of the literature. As well, four models of community development are synthesised from literature in sociology, social psychology, education and political science. These include economic development models, education models both formal and informal, confrontational models, and empowerment models. Each is discussed, and the relevance for community health nursing practice is critiqued. Finally, issues which may arise when community health nurses attempt to practice within a community development model are discussed. Issues are examined related to the structures of organizations in which nurses work, characteristics of nurses themselves, and the communities which nurses serve. The argument is advanced that despite the pitfalls and problems, this new role shows promise as an important mechanism for community health nurses to promote the community's health. However, much additional work will be needed to test out models for community development in actual practice. Evaluation of the role will also be important to determine the degree to which it can be implemented and the resultant health outcomes for the population.

Canada↗
PubMed1999

Agriculture sector resource and environmental policy analysis: an economic and biophysical approach.

Agricultural pollution of the environment is jointly determined by economic decisions driving land use, production practices, and stochastic biophysical processes associated with agricultural production, land and climate characteristics. It follows that environmental and economic statistics, traditionally collected independently of each other, offer little insight into non-point pollutant loadings. We argue that effective policy development would be facilitated by integrating environmental and economic data gathering, combined with simulation modelling linking economic and biophysical components. Integrated data collection links economics, land use, production methods and environmental loadings. An integrated economic/biophysical modelling framework facilitates policy analysis because monetary incentives to reduce pollution can be evaluated in the context of market costs and returns that influence land use and production activity. This allows prediction of environmental and economic outcomes from alternative policies to solve environmental problems. We highlight steps taken to merge economic and biophysical modelling for policy analysis within the Economic Research Service of the United States Department of Agriculture. An example analysis of a policy to reduce agricultural nitrogen pollution is presented, with the economic and environmental results illustrating the value of linked economic and biophysical analysis.

Agriculture↗
PubMed2001

[Cost-effectiveness of PET in the management algorithms of lung tumors: comparison of health economic data].

Modelling is an accepted, valid and often necessary method for assessing economic effectiveness in terms of cost per life year gained. Comparing an alternative strategy (a) with a baseline strategy (bl), the incremental cost (COSTa-COSTbl) divided by the incremental life expectancy (LEa-LEbl) defines the incremental cost-effectiveness ratio (ICER). Taking watchful waiting as the low-cost baseline strategy for the management of solitary pulmonary nodules, the ICER of positron emission tomography (PET) [3218 euros (EUR) per life year saved (LYS)] was more favourable than that of exploratory surgery (4210 EUR/LYS) or that of transthoracic needle biopsy (6120 EUR/LYS). Changing the baseline strategy to exploratory surgery, the use of PET led to cost savings and additional life expectancy in case of an intermediate pretest probability of malignancy. For management of potentially operable non-small cell lung cancer the use of PET in patients with normalisized mediastinal lymph nodes on CT was most cost-effective (143 EUR/LYS), and the costs of PET were almost balanced by a better selection of patients for beneficial cancer resection. Using PET in patients with enlarged lymph nodes on CT, the ICER raised to 36,667 EUR/LYS. When PET or CT were positive for mediastinal lymph nodes, the exclusion from biopsy confirmation led to cost savings that did not justify the expected reduction in life expectancy. Economic data from the USA and Japan also demonstrated the cost-effectiveness of PET-based algorithms for the management of lung tumours.

Algorithms↗
PubMed2005

Influence of clinical outcome and outcome period definitions on estimates of absolute clinical and economic benefits of influenza vaccination in community dwelling elderly persons.

Studies assessing the clinical and economic benefits of vaccination in the elderly have used different clinical outcomes (e.g. hospitalizations for pneumonia or influenza versus hospitalizations for respiratory and cardiovascular causes) and different outcome periods (e.g. peak versus total influenza season) on which to base estimates of clinical effectiveness and cost effectiveness. We explored the implications of these varying approaches by comparing two health economic analysis models of influenza vaccination of community-dwelling elderly persons. We developed computerized models using clinical data from 3 large US HMOs for the 1998-1999 and 1999-2000 influenza seasons. The primary health economic model used a broad definition of clinical events and outcome period and included hospitalizations for all respiratory and cardiovascular events that occurred during the entire influenza season. The alternative model used more restrictive definitions and included pneumonia or influenza hospitalizations occurring during the peak influenza season. The results of Monte Carlo simulation showed that, with the more inclusive primary model, influenza vaccination resulted in net medical care cost savings due to fewer respiratory or cardiovascular hospitalizations of Dollars 71/person vaccinated (5th-95th percentile Dollars 32-118) and net savings of Dollars 809/year of life saved (5th-95th percentile Dollars 331-1450). In contrast, the alternate model found costs of Dollars 3.50/person vaccinated (5th-95th percentile Dollars -11 to 5) and net costs of Dollars 91/year of life saved (5th-95th percentile Dollars -309 to 126). Our findings confirm that influenza vaccination of the elderly is most likely cost saving and supports policies and programs that advocate routine immunization of all persons 65 and older. They also highlight how different outcome definitions can influence the results of health economic analyses.

Aged↗
PubMed1991

Convenience and independence: do physicians strike a balance in admitting decisions?

This paper contrasts economic and professional models of physician admitting behavior. Economic models emphasize physician convenience and income maximization, while professional models emphasize physician autonomy and independence. The paper examines the relative power of these models to explain two types of admitting decisions made by physicians: which hospitals to begin admitting patients to, and how many patients to admit to a hospital. Analyses of physician admitting patterns over a three-year period suggest that economic considerations outweigh professional considerations in both decisions. Results are interpreted in light of recent changes in the profession of medicine and physician-hospital relationships.

Consultants↗
PubMed2000

The Swedish ACCES model: predicting the health economic impact of celecoxib in patients with osteoarthritis or rheumatoid arthritis.

The Arthritis Cost Consequence Evaluation System (ACCES) pharmacoeconomic model was used to evaluate the economic and health impact of the recent introduction of celecoxib for treatment of osteoarthritis (OA) and rheumatoid arthritis (RA) in Sweden. The model demonstrates that use of celecoxib can be expected to reduce the incidence of gastrointestinal adverse events, resource utilization and treatment costs. In a cost-effectiveness analysis, celecoxib demonstrated economic dominance (i.e. improved health at reduced cost) compared with the currently available alternatives for OA, and demonstrated economic dominance against a clinically relevant base-case scenario for RA. In sensitivity analyses, the results were shown to be relatively robust; celecoxib demonstrated economic dominance or favourable cost-effectiveness ratios in all analyses. Based on these data, it can be concluded that the use of celecoxib in Sweden will provide societal benefits by improving health care at reduced cost for patients with OA and RA.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1994

Using Gini-style indices to evaluate the spatial patterns of health practitioners: theoretical considerations and an application based on Alberta data.

The paper analyzes how Gini-style indices are optimally used in the evaluation of economic spatial models designed to predict where health care practitioners are likely to locate under competitive market conditions. At a conceptual level, the analysis establishes that Gini-style indices can be brought to bear on economic models, only if the ordering of geographic areas required to give Gini-coefficient values internal technical coherence also has meaning in terms of the conceptual predictions of the modelling. This, in turn, implies that Gini-indices are most likely to prove useful for fairly aggregated forms of economic analysis, involving relatively few and large geographic divisions. At an applied level, the analysis establishes that one particular geographic distribution of health practitioners is empirically dominant, and that is the distribution which involves the lowest practitioner:population ratio in rural areas, and the highest ratio in large urban areas, with the ratio for small urban areas in between. The empirical evidence also suggests that the spatial practitioner distributions are highly stable for most kinds of health personnel, making it problematic whether these distributions can be changed through normal types of public policy interventions.

Alberta↗
PubMed2005

A spreadsheet-based model demonstrating the nonuniform economic effects of varying reproductive performance in Ohio dairy herds.

A spreadsheet-based model was developed to estimate the economic effect of varying reproductive performance in dairy herds. Scenarios were created to model an average cow with respect to production, herd lifetime, and reproductive events. Average milk yield per day of life as well as lifetime calf and replacement heifer production were examined. Additional inputs representing milk, feed, semen, calf, and salvage prices were used to calculate net cash flow for each day of herd life for the average cow in a scenario. Economic comparison of different scenarios was accomplished using an equivalent annual cash flow (annuity) methodology.Herd performance measures and prices representative of Ohio dairy herds were used to establish a baseline average cow that had a 160-d calving-to-conception interval [days open (DO)]. Alternative scenarios that differed from baseline in DO, annual culling rate, and feed and milk prices were created to characterize the effects of changes. Under scenario inputs representative of typical Ohio dairy herds, the model indicated that a lower annual culling rate (25%) was preferable to higher annual culling rates (34 or 45%). The model estimated maximum average milk yield per day of life to occur at 110 DO. At 34% annual culling rate, calves and replacement heifers produced per lifetime declined as DO increased; beyond 150 DO, the modeled cow produced less than 1 replacement heifer per lifetime. The model also estimated a loss of $1.37 per cow per year for a 1-d increase in DO beyond 160 d. At 20% higher feed and milk prices, the model estimated a loss of $1.52 per cow per year; at 20% lower feed and milk prices, the model estimated a loss of $1.23 per cow per year. Furthermore, the model suggested that the loss associated with a 1-d increase in DO changed as DO changed. Using baseline inputs, the model calculated losses for a 1-d increase of $0.44 per cow per year at 130 DO and $1.71 per cow per year at 190 DO. The nonuniform nature of the cost of additional DO is important to veterinarians and producers. The implication is that inefficient reproduction becomes marginally more costly to producers as performance declines and warrants increased attention. Conversely, marginal benefits of improved reproduction decrease as performance improves. Herds with strong reproductive performance have less opportunity to capture economic benefits of improvement.

Animals↗
PubMed2004

Comparing demand functions when different price manipulations are used: does unit price help?

Six hens pecked a key (Experiment 1) or pushed a door (Experiment 2) to obtain food reinforcement. In both experiments and as an analogue of price changes, the response requirements were varied in two ways: by increasing the number of responses required and by increasing the required force of each response. The two price manipulations (response number and response force) had different effects on behavior and produced different-shaped demand functions when the rates of consumption were plotted logarithmically against the price analogues. Irrespective of response topography, when the number of required responses was varied, the data paths appeared linear, with slopes close to -1.0. When the required force of each keypeck and doorpush was varied, the data paths were clearly curved, with increasingly steep downward slopes as the force increased. Using the concept of unit price did not fully remove the different effects of the two price manipulations. Those differences are best attributed to the differing times needed in order to complete each response unit under those price manipulations.

Animals↗
PubMed2001

Development of the health and economic consequences of smoking interactive model.

OBJECTIVE: To describe the health and economic consequences of smoking model, a user friendly, web based tool, designed to estimate the health and economic outcomes associated with smoking and the benefits of smoking cessation. RESULTS: An overview of the development of the model equations and user interface is given, and data from the UK are presented as an example of the model outputs. These results show that a typical smoking cessation strategy costs approximately 1200 pounds sterling per life year saved and 22,000 pounds sterling per death averted. CONCLUSIONS: The model successfully captures the complexity required to model smoking behaviour and associated mortality, morbidity, and health care costs. Furthermore, the interface provides the results in a simple and flexible way so as to be useful to a variety of audiences and to simulate a variety of smoking cessation methods.

Health Promotion↗