Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “ECONOMICS”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 1,045 records · Page 58Linked to original sources
PubMed2004

[National Health Innovation System: relations between scientific fields and economic sectors].

Health Science and Technology is currently the subject matter of government and university actions. Such actions should converge to the establishment of a National Health Innovation System, which still calls for acknowledgment from the economic sector counterpart. A study was carried out with the purpose of describing the relations between scientific fields and economic sectors as a means of learning more about this System. Records from the Brazilian Directory of Research Groups (version 4.1) were examined and selected when Health was a keyword either to field of knowledge or economic sector. Data were compiled into multiresponse variables and analyzed in contingency tables using residual, correspondence, and cluster analyses. It was found that the Brazilian National Health Innovation System constitutes a sectorial system where competitiveness is more socially than economically-oriented, making this System favorably in tandem with the National Unified Health System as well as responsive to public policies focused on social welfare.

Biomedical Research↗
PubMedDate not supplied

[Economic crisis and infant mortality in Latin America since the 1980's].

In the present study, based on data from nine Latin American countries, we found evidence of an association between the economic crisis and infant mortality during the last decades. The paper initially review previous studies on this issue and shows the need for a greater research focus on shorter time intervals. We then describe the deterioration and unequal conditions among the countries based on trends in selected social and economic indicators and the evolution of infant mortality rates. According to our statistical analysis, infant mortality bore an inverse association to short-term economic variations. We also found a significant and negative correlation between decreasing infant mortality rates and increasing poverty. The economic crisis displayed effects of varying intensity among the countries we analyzed, with social inequality appearing as the most probable explanatory variable.

Economics↗
PubMed2006

When are no-take zones an economically optimal fishery management strategy?

Discussions on the use of marine reserves (no-take zones) and, more generally, spatial management of fisheries are, for the most part, devoid of analyses that consider the ecological and economic effects simultaneously. To fill this gap, we develop a two-patch ecological-economic model to investigate the effects of spatial management on fishery profits. Because the fishery effects of spatial management depend critically on the nature of the ecological connectivity, our model includes both juvenile and adult movement, with density dependence in settlement differentiating the two types of dispersal. Rather than imposing a reserve on our system and measuring its effect on profits, we ask: "When does setting catch levels to maximize system-wide profits imply that a reserve should be created?" Closing areas to fishing is an economically optimal solution when the value derived from spillover from the reserve outweighs the value of fishing in the patch. The condition, while simple to state in summary form, is complex to interpret because it depends on the settlement success of the dispersing organisms, the nature of the costs of the fishing, the economic and ecological heterogeneity of the system, the discount rate, and growth characteristics of the fish population. The condition is more likely to be satisfied when the closed area is a net exporter of biomass and has higher costs of fishing, and for fish populations with density-independent settlement ("adult movement") than with density-dependent settlement ("larval dispersal"). Rather surprisingly, there are circumstances whereby closing low biological productivity areas, and even sometimes low cost areas to fish, can result in greater fishing profits than when both areas are open to fishing.

Animals↗
PubMed1996

Basic framework for the economic evaluation of animal health control programmes.

The further integration of international markets means that co-ordinated policies against contagious animal infections have become increasingly important, and stricter demands for control and eradication should be expected in the future. To meet these demands, it would be desirable to create a computer simulation environment in which 'what if?' scenarios could be performed, in order to explore the epidemiological and economic effects of various infections and control strategies. The authors propose a flexible economic framework and illustrate this framework with an example. The framework has four elements: changes in the percentage of infectious herds, changes in product quantities, changes in product prices and economic integration. Each element is specifically defined and has its own input and output data, depending on the control strategy under consideration. In an illustration of the framework, probability distributions of the different control strategies are compared and the optimal strategy is chosen, according to the attitude of the decision-maker towards risk. Such a framework can be considered as a new standardised approach for comparing and selecting animal health control strategies, by integrating technical and economic data and principles.

Animal Diseases↗
PubMed2005

An economic evaluation of operative compared with nonoperative management of displaced intra-articular calcaneal fractures.

BACKGROUND: The choice of therapy for a displaced intra-articular calcaneal fracture has long been a source of uncertainty in orthopaedic surgery, both in terms of the impact of the therapy on clinical outcomes and on health-care and non-health-care costs. We performed an economic evaluation, based on the results of a randomized clinical trial, to evaluate the economic implications of operative compared with nonoperative management of this fracture. METHODS: An economic evaluation was performed, with use of a four-year time horizon, to determine the effect on costs and health benefits of operative compared with nonoperative management for a group of patients with displaced intra-articular fractures of the calcaneus. The complication rate, arthrodesis rate, survival data, and health-outcome data were estimated prospectively from a recent randomized clinical trial. Direct health-care costs and indirect costs (the cost of time lost from work) were estimated retrospectively from the center treating the majority of the patients. RESULTS: Operative management resulted in a lower rate of subtalar arthrodesis and a shorter time off from work compared with nonoperative treatment. When indirect costs, such as the time lost from work, were included in the analysis, operative management was less costly (an average savings of Can$19,000 per patient) and more effective, thus making it the preferred strategy. The result was most sensitive to the estimates of the costs of time lost from work. When these costs were excluded, operative treatment remained more effective, but with an increased average cost of Can$2800 per patient. CONCLUSIONS: Calcaneal fractures have been recognized as having relatively poor clinical outcomes and a major socioeconomic impact with regard to time lost from work and recreation. Our analysis suggests that operative management of displaced intra-articular fractures is economically attractive. However, further exploration of the impact and valuation of time lost from work and patient outcomes is required.

Calcaneus↗
PubMed1992

Economic analysis as an aid to subsidisation decisions: the development of Australian guidelines for pharmaceuticals.

Factors governing the entry of new drugs into clinical practice are changing, with increasing emphasis on economic issues. In future, organisations that subsidise the use of pharmaceuticals are likely to require sponsors to provide evidence of the cost-effectiveness of their products. The first national government to signal such an intention is the Commonwealth Government of Australia, which from January 1993 will require economic analyses in support of applications for listing of new pharmaceutical products on its schedule of pharmaceutical benefits. This move is underpinned by legislation that requires the country's Pharmaceutical Benefits Advisory Committee (PBAC) to consider costs and effectiveness when recommending listing of new drugs. The approach that has been recommended to the Committee is based on advice from a group of consultants, health economists and clinicians. The PBAC will use economic analyses as an aid to decision-making that will remain within a clinical framework; the viewpoint will be societal, and analyses will include costs that fall outside the pharmaceutical benefits scheme. The preferred approach is comparative cost-effectiveness analysis with a particular emphasis on the marginal costs of obtaining additional health benefits with new drugs, compared with existing therapies. The use of analyses that are restricted to potential cost savings with new drugs is discouraged, as is the inclusion of indirect costs and benefits. To facilitate the conduct of economic analyses, it is planned to hold meetings with specialist clinicians to obtain consensus on a range of intermediate clinical outcome indicators, and to publish lists of 'standard' Australian costs that will be updated regularly. The approach being followed in Australia has implications for both the government and the pharmaceutical industry. The responsibility for monitoring the effects of this new policy lie with the government. The success, or otherwise, of the policy should not be gauged simply by the effects on the price of new drugs which, historically, have been relatively low in Australia. A full evaluation will require that more effort be put into clinical outcomes research and the development of population databases, an area in which Australia lags behind other countries.

Australia↗
PubMed1992

Clinical economics: a method for prospective health resource data collection.

Information about the economic benefit of new drugs is becoming increasingly important for formulary considerations, reimbursement policies and related considerations. Although economic benefits of drugs have been analysed and reported, the economic benefits of drugs have rarely been examined in the course of randomised therapeutic trials. We designed a modular survey instrument, the Resource Utilisation Survey (RUS), to collect economic outcomes in prospective trials. A pilot test of the RUS was conducted using clinical trial methods in a study of nizatidine versus placebo in preventing ulcers induced by nonsteroidal anti-inflammatory drugs. The purpose of the pilot study was to evaluate the RUS instrument and corresponding study design issues in clinical trials for either acute or chronic diseases. With the lessons learned from the pilot study, the RUS has been used successfully in other ongoing clinical trials.

Economics, Pharmaceutical↗
PubMed1993

Guidelines for economic analysis of pharmaceutical products: a draft document for Ontario and Canada.

In Canada, provincial formulary review committees consider the effectiveness, safety, and cost of products when they derive advice for each Minister of Health. This article offers a draft set of guidelines for pharmaceutical manufacturers making submissions which include economic information, moving beyond a simple presentation of the unit price of the pharmaceutical product (e.g. price per day or course of therapy) and comparison to similar prices for alternative products. A full economic analysis compares all relevant costs and clinical outcomes of the new product with alternate therapeutic strategies for treating patients with a particular condition. The perspective of the decision maker must be clearly identified. The quality of the evidence supporting estimates of the variables incorporated in the analysis should be evaluated. Sensitivity analyses are used to assess the robustness of the qualitative conclusions. Reviewers will examine the answers to a set of 19 questions. Manufacturers can use these questions as a worksheet for preparation of an economic analysis to be incorporated in a submission. These guidelines are intended to be a starting point for further refinement, and discussion with health economists in industry and academia. Considerable flexibility will be used in reviewing documentation supporting economic analysis. Those preparing submissions should be encouraged to experiment with various approaches as part of the general development of this field and to engage provincial review committees in ongoing discussions.

Canada↗
PubMed1997

Sensitivity analysis in health economic and pharmacoeconomic studies. An appraisal of the literature.

The objective of this study was to analyse the extent of reporting of sensitivity analyses in the health economics, medical and pharmacy literature between journal types and over time. 90 articles were chosen from each of the bodies of literature on health economics, medicine and pharmacy. MEDLINE, EMBASE and International Pharmaceutical Abstracts were searched for English-language economic studies published between 1989 and 1993. The studies chosen for inclusion had to be original articles published in one of the selected journals between January 1989 and December 1993, involving a comparison between drugs, treatments or services, and evaluating both costs and outcomes. 123 articles initially met these criteria; however, 16 were inappropriate, 17 were randomised out, leaving 90 studies (73%) that were used (30 from each literature group). Data were extracted independently by 5 raters using a validated checklist. Inter-rater reliability was assessed by calculating kappa. 53 of the 90 articles (59%) conducted sensitivity analyses. 39 (74%) stated explicitly that a sensitivity analysis was being performed; this was noted in the Methods section of 35 papers (67%). 80% of health economics journals, 70% of medical journals and 20% of pharmacy journals conducted sensitivity analyses. Despite the fact that all published pharmacoeconomic guidelines suggest the use of sensitivity analysis, only 59% of studies between 1989 and 1993 did so. Improvement is required, especially in the pharmacy literature. No time trends in the conduct of sensitivity analyses were detected. However, the sample may not have been sufficient to detect such trends. Pharmacoeconomic guidelines should provide more details on preferred methods of sensitivity analysis and on desired parameters.

Economics, Pharmaceutical↗
PubMed2001

Economic analysis of initial HIV treatment. Efavirenz- versus indinavir-containing triple therapy.

OBJECTIVE: To compare the clinical and economic outcomes associated with triple therapy containing efavirenz or indinavir and 2 nucleoside reverse transcriptase inhibitors (NRTIs; zidovudine and lamivudine) in HIV-positive patients. DESIGN AND SETTING: An economic model based on viral load and CD4+ cell counts to predict long term outcomes such as progression to AIDS and AIDS-related death was developed and then analysed using data from a randomised clinical trial. Cost estimates from the healthcare system perspective were based on data from 6 state, all-payor databases, the AIDS Cost and Services Utilisation Study, and other literature. Analyses were carried out for time horizons between 5 and 15 years. PATIENTS AND INTERVENTIONS: HIV-positive patients with limited exposure to NRTIs. Initial regimens consisted of efavirenz or indinavir, each combined with 2 NRTIs. A maximum of 2 switches to other regimens was permitted. MAIN OUTCOME MEASURES AND RESULTS: The efavirenz-containing triple therapy regimen was predicted to prolong survival at a savings of up to 10,923 US dollars (1998 values) relative to initial therapy with the indinavir-containing regimen. Patients who receive efavirenz are expected to have 11% greater survival at 5 years and fewer treatment failures (28 vs 52%, at 2 years). Overall, the economic and health benefits predicted for the efavirenz-containing regimen were robust to reasonable variation in key parameters. CONCLUSIONS: The superior clinical trial outcomes for efavirenz-containing regimens should translate into substantial economic and health benefits.

Acquired Immunodeficiency Syndrome↗
PubMed2003

Economic evaluations of varicella vaccination programmes: a review of the literature.

Chickenpox infections are generally mild but due to their very high incidence among healthy children they give rise to considerable morbidity and occasional mortality. With the development of a varicella vaccine in the early 1970s and its progressive licensing in many countries, interest in the efficiency of varicella immunisation programmes grew. The objective of this review was to discuss the methodological aspects and results of published economic evaluations of varicella vaccination. From this, we attempted to make recommendations. A computerised search was carried out; 17 full economic evaluations of varicella vaccination were retrieved. The review identified the methodological divergences and similarities between the articles in four areas: study design, epidemiological data, economic data and model characteristics. We assessed to what extent the applied methods conform to general guidelines for the economic evaluation of healthcare interventions and compared the studies' results. The desirability of a universal vaccination programme depends on whose perspective is taken. Despite variability in data and model assumptions, the studies suggest that universal vaccination of infants is attractive to society because large savings occur from averted unproductive days for parents. For the healthcare payer, universal vaccination of infants does not generate savings. Vaccination of susceptible adolescents has been proposed by some authors as a viable alternative; the attractiveness of this is highly dependent on the negative predictive value of anamnestic screening. Targeted vaccination of healthcare workers and immunocompromised individuals appears relatively cost effective. Findings for other target groups are either contradictory or provide insufficient evidence for any unequivocal recommendations to be made. High sensitivity to vaccine price was reported in most studies. This review highlights that some aspects of these studies need to be further improved before final recommendations can be made. First, more transparency, completeness and compliance to general methodological guidelines are required. Second, because of the increasing severity of varicella with age, it is preferable and in some cases essential to use dynamic models for the assessment of universal vaccination strategies. Third, most studies focused on the strategy of vaccinating children only while their results depended heavily on disputable assumptions (regarding vaccine effectiveness and impact on herpes zoster). Since violation of these assumptions could have important adverse public health effects, we suggest pre-adolescent vaccination as a more secure alternative. This option deserves more attention in future analyses.

Chickenpox↗
PubMed2003

Assessing the economic impact of adverse drug effects.

Although most commonly used drugs cause adverse effects, some of them with potentially serious consequences, relatively little is known about their economic impact. The purpose of this review is to summarise information describing the cost of treatment of drug-induced adverse effects as an additional cost of pharmaceutical treatment. The focus of this study was limited to the overall economic impact of drug-related morbidity and to the economic analysis of a single class of drugs with different safety profiles. Several studies carried out in the US have investigated adverse drug effects experienced by hospitalised patients and their impact on hospital costs. Patients who developed adverse effects were hospitalised an average of 1.2-3.8 days longer than patients who did not, with additional hospital costs of $US2284-5640 per patient (2000 values). Other research studies in different countries have quantified the incidence and economic consequences of adverse drug effects that occur in the ambulatory setting and that generate hospital admission and emergency department visits. They have shown that preventable adverse effects constitute between 43.3% and 80% of all adverse outcomes leading to emergency visits and hospital admissions, and disproportionately increase healthcare costs. Finally, a recent estimation revealed that in the US the cost of problems linked to drug use in the ambulatory setting exceeded $US177 billion in the year 2000.NSAIDs constitute a widely used class of drugs and they are one of the leading drug classes in causing adverse effects. The acquisition costs of the drugs, as well as the costs for prevention and treatment of adverse effects, determine their cost-effectiveness ratio. Depending on the incidence and severity of adverse effects, the cost per adverse effect avoided ranges from $US215 to $US35 459 (2000 values). According to the contingent valuation methodology, willingness to pay to avoid or reduce the incidence of adverse effects is an indicator of the value individuals associate with the impact of such effects on their well-being. Individuals are willing to pay annually an average of $US240 and $US350, respectively, to avoid vomiting and gastrointestinal distress induced by NSAIDs. Although the results of the different studies reviewed are not strictly comparable because of differences in the severity of adverse effects, the perspective of the analysis, the cost data included and the cost component considered, the data show that, apart from the implications for health, a substantial quantity of resources are used to treat adverse effects.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed2004

A decision chart for assessing and improving the transferability of economic evaluation results between countries.

OBJECTIVE: To develop a user-friendly tool for managing the transfer of economic evaluation results. METHODS: Factors that may influence the transfer of health economic study results were systematically identified and the way they impact on transferability was investigated. A transferability decision chart was developed that includes: knock-out criteria; a checklist based on the transferability factors; and methods for improving transferability and for assessing the uncertainty of transferred results. This approach was tested on various international cost-effectiveness studies in the areas of interventional cardiology, vaccination and screening. RESULTS: The transfer of study results is possible pending the outcomes of the transferability check and necessary adjustments. Transferability factors can be grouped into areas of methodological, healthcare system and population characteristics. Different levels of effort are required for analysis of factors, ranging from very low (e.g. discount rate) to very high (e.g. practice variation). The impact of differences of most transferability factors can be estimated via the key health economic determinants: capacity utilisation, effectiveness, productivity loss and returns to scale. Depending on the outcomes of the transferability check a correction of the study results for inflation and for differences related to currencies or purchasing power might be sufficient. Otherwise, modelling-based adjustments might be necessary, requiring the (re-)building and sometimes structural modification of the study model. For determination of the most essential adjustments, a univariate sensitivity analysis seems appropriate. If not all relevant study parameters can be substituted with country-specific ones, multivariate or probabilistic sensitivity analysis seems to be a promising way to quantify the uncertainty associated with a transfer. If study results cannot be transferred, the transfer of study models or designs should be investigated as this can significantly save time when conducting a new study. CONCLUSIONS: Our transferability decision chart is a transparent and user-friendly tool for assessing and improving the transferability of economic evaluation results. A state of the art description of the methodology in a study, providing detailed components for calculation, is not only essential for determining its transferability but also for improving it via modelling adjustments.

Cost-Benefit Analysis↗
PubMed2006

Economic evaluation in the US: what is the missing link?

In this paper we consider the evolving American healthcare landscape and what it means for the use of economic evaluation of health interventions. We emphasise that use of economic evaluation in the US is unlikely to follow the European, Canadian or Australian models, which use cost effectiveness openly and explicitly, given the decentralised manner in which American healthcare is organised, financed and delivered, as well as different political systems and traditions, and cultural expectations and attitudes surrounding healthcare. However, this does not mean that considerations of value are absent. On the contrary, measurement of value remains near the top of the agenda among US policy makers. With a few exceptions, it just isn't playing out explicitly. In the American context, it means in part heightened debate over clinical evidence, and cost sharing. In some cases, payers are also considering economic evaluation more directly in coverage and reimbursement decisions and indirectly for clinical practice guidelines and best practice recommendations. A dramatic shift in policy towards cost effectiveness seems unlikely in the near future. Change will likely come in incremental fashion through experimentation, and perhaps in selected circumstances with public and private leaders willing to take the political risks. Conceivably, more substantial change will occur with a major shift in the political leadership in Washington, DC in the legislative or executive branches, and/or with an economic downturn and severe pressures on federal and state health budgets. However, a more likely outcome is the ongoing indirect use of cost-effectiveness information.

Delivery of Health Care↗
PubMed2005

Epidemiology and health economics of COPD across Europe: a critical analysis.

COPD is a major cause of morbidity and mortality in Europe. The purpose of this literature review was to critically evaluate published data on COPD prevalence and the cost of COPD interventions in European countries. Selection of literature was based on article retrieval from a systematic literature search using PubMed and EMBASE. Only articles providing data in European countries published between January 1990 and March 2003 were included. European epidemiological (cross-sectional, cohort, case-control) and economic (cost-of-illness-, cost-minimization-, cost-effectiveness-, cost-benefit-, cost-utility-analysis) studies were included. Of 74 retrieved epidemiologic studies, only seven (9%) fulfilled the inclusion criteria. In the selected literature, COPD prevalence ranged from 3% among Finnish women to 57% among Italian men and women, 45 years and older. Of 56 economic studies, 24 satisfied entry criteria. Results from the final cost-of-illness studies indicated that hospital care and medication represented the major portion of costs associated with COPD. In a survey conducted in 1998/99, annual direct expenditures for COPD treatment per patient in Europe ranged from Euro 530 in France to Euro 3238 in Spain. There was a differential increase in COPD prevalence predominantly related to an aging patient population, with a high incidence of exposure to cigarette smoke. Data also showed differences in the economic impact of COPD in Europe based on the proportion of patients with severe COPD, frequency of exacerbations, and number of hospitalizations. Overall, results of this review demonstrated the need for global epidemiologic and economic studies to allow for more uniform guidelines for the prevention and cost-effective treatment of patients with COPD.

Cost-Benefit Analysis↗
PubMed1984

Women and the economics of aging.

Economic and policy arrangements assure the maintenance of gender-based inequities throughout the life cycle. To understand the economics of aging requires consideration of the problems of women of all ages, commencing early in the adult life cycle when the different social roles and opportunity structures available to men and women take effect. Because the economic inequities suffered by women in old age derive principally from inequities suffered earlier as wives and workers, public policy focused on redressing income in old age does nothing to alter the structural basis of inequity. This article examines factors underlying the economics of aging for older women in the United States; delineates the relation between women's roles, social policy, and income; and raises salient policy questions for younger and older women.

Aged↗
PubMed1999

Economic values for meat quality traits in pigs.

The aim for this study was to derive economic values for meat quality traits. Meat quality experts from 10 slaughter and retail companies in Switzerland were asked to give an interview in which they indicated their willingness to pay different prices for carcasses from different quality classes. Economic values for the seven meat quality traits color (L*), drip loss, intramuscular fat content, iodine value, pH1 (45 min after slaughtering), pH2 (24 to 30 h after slaughtering), and proportion of premium cuts were derived from the answers. For each trait, a weighted mean of these economic values was calculated using the number of pigs slaughtered by a company per year as a weighting factor. Population mean and standard deviation of the investigated traits were taken from station test results of Swiss Large White pigs (intramuscular fat content, iodine value, pH1, pH2, and proportion of premium cuts) and from the literature (color and drip loss). Weighted means (range among companies) of economic values per slaughter pig on the basis of one phenotypic standard deviation of the trait in Swiss Francs (SFr.) were -22.92 (0 to -62.46) for color, -10.27 (0 to -43.64) for drip loss, 10.84 (0 to 29.43) for intramuscular fat content, -29.90 (-15.54 to -43.58) for iodine value, 11.50 (.67 to 19.79) for pH1, 0 (0) for pH2, and 10.92 (-2.30 to 33.67) for proportion of premium cuts.

Animals↗
PubMed2005

A partial budget model to estimate economic benefits of lactational treatment of subclinical Staphylococcus aureus mastitis.

Subclinical Staphylococcus aureus mastitis is rarely treated during lactation because it is widely believed to be uneconomical, although there are no economic studies that support this view. Partial budgeting was used to develop a deterministic simulation model to estimate the net cost or benefit of antibiotic treatment of subclinical S. aureus mastitis during lactation. Direct and indirect effects of treatment were taken into account, including prevention of clinical flare-ups and contagious transmission. Input variables were based on literature and on 2003-2004 prices in the Netherlands. When contagious transmission of S. aureus was likely (reproductive ratio R = 5.3), 3- and 8-d treatments resulted in an average net profit of 95.62 euros and 142.42 euros, respectively, compared with no treatment. When the probability of S. aureus transmission was low (R = 0.32), the average economic benefit of 3- or 8-d treatment was -21.12 euros and -57.70 euros, respectively. On low-transmission farms, 3-d treatment was profitable when the appropriate cows were selected for treatment using known risk factors for cure. Sensitivity analysis showed that the 6 most influential input variables in the model were chance of bacteriological cure, R, probability of culling, retention pay-off, and cost of antibiotics and bacterial culture. Although the economic outcome of lactational treatment of subclinical S. aureus mastitis is highly herd-, cow-, and strain-dependent, treatment is economically justified in many situations.

Animals↗