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PubMed1995

Economic evaluation using mathematical models: the case of misoprostol prophylaxis.

Using misoprostol prophylaxis as an example, many of the methods employed in economic analyses that incorporate mathematical models were described. These included: decision analysis, cost effectiveness analysis (including incremental cost effectiveness analysis), one-way, multi-way, and probabilistic sensitivity analysis, and the estimation of quality adjusted life years for use in cost utility analysis. In the case of misoprostol prophylaxis, the cost effectiveness analysis demonstrated that, compared to the no prophylaxis alternative, prophylaxis cost an extra $650, on average, for every additional ulcer prevented, and was potentially cost saving for some high risk groups. The cost utility analysis demonstrated that prophylaxis resulted (on average) in modest additional costs and no additional quality of life benefits. Sensitivity analysis demonstrated that, at worst, prophylaxis reduced quality of life; at best, the incremental cost effectiveness ratio was $9333 for each quality adjusted life-year gained by prophylaxis compared to no prophylaxis. The results of the cost utility analysis also showed that prophylaxis may be cost saving in high risk groups, confirming the results of the cost effectiveness analysis. Finally, and perhaps most importantly, this analysis illustrated the importance of incorporating measures of health related quality of life into economic evaluation.

Cost-Benefit Analysis↗
PubMed2004

Clinical effectiveness and cost-effectiveness of neonatal screening for inborn errors of metabolism using tandem mass spectrometry: a systematic review.

OBJECTIVES: To evaluate the clinical and cost-effectiveness of tandem mass spectrometry (MS)-based neonatal screening for inborn errors of metabolism (IEM). DATA SOURCES: Fourteen electronic bibliographic databases covering biomedical, science, economic and grey literature, the reference lists of relevant articles and abstracts of conference proceedings and 18 health services research-related resources. REVIEW METHODS: This review is an update of two previous HTA reports of neonatal screening for IEM. These reports have been updated by a systematic review of published research (between 1995 and January 2002) on neonatal screening of inherited metabolic disorders using tandem MS. This was supplemented by a search for economic literature and the application of a modelling exercise to investigate the economics of using tandem MS within a neonatal screening programme in the UK. RESULTS: Evidence from the reviews of IEM found that the UK screening programme for phenylketonuria (PKU) was well established and there was universal agreement that neonatal screening for PKU was justified. Of the many other disorders that can be detected by tandem MS, the best candidate condition for a new screening programme was medium-chain acyl-coenzyme A dehydrogenase (MCAD) deficiency. For many other IEM that can be detected by tandem MS, robust clinical evidence was limited. Cost-effectiveness analysis using economic modelling indicated that substituting the use of tandem MS for existing technologies for the screening of PKU alone could not be justified. However, results from the economic modelling indicate that the addition of screening for MCAD deficiency as part of a neonatal screening programme for PKU using tandem MS would be economically attractive. Using an operational range of 50,000-60,000 specimens per system per year, the mean incremental cost for PKU and MCAD deficiency screening combined using tandem MS from the model was -23,312 British pounds for each cohort of 100,000 neonates screened. This cost saving is associated with a mean incremental gain of 59 life-years. Additional economic modelling using the available evidence does not support including other inherited metabolic diseases within a neonatal screening programme at present. CONCLUSIONS: The evidence appears to support the introduction of tandem MS into a UK neonatal screening programme for PKU and MCAD deficiency combined. Tandem MS has the potential for simultaneous multi-disease screening using a single analytical technique. Although the marginal cost of extending the programme to include other conditions may be relatively small, the application of this new technology to PKU and MCAD deficiency screening does not imply the wholesale inclusion of all disorders detectable by tandem MS. It is suggested that the primary focus of further research should be on the long-term effectiveness of treatment strategies on adverse outcomes (disabilities and impairments) under conventional management and the potential impact of early diagnosis using tandem MS.

Cohort Studies↗
PubMed1984

The migration function and the Todaro paradox.

"The purpose of this paper is to present a microeconomic foundation of the migration function and to discuss the impact of an increase in the job creation rate on migration and urban unemployment. Each rural worker must estimate his expected urban income on the basis of his own expected numbers of both newly created jobs and migrants during the coming period. Workers whose expected urban income is greater than the rural one decide to migrate, while those who estimate smaller urban income stay on." The geographical focus is on developing countries.

Behavior↗
PubMed1988

On generalizing the economic analysis of international migration: a note.

The author critically examines an article by Kar-Yui Wong concerning "two important, well-known propositions on international factor movements--namely, first, finite international factor movements are beneficial to the nationals of the destination-country but detrimental to those who are left behind in the source-country; and second, marginal movements do not have such welfare implications.... The present paper, by utilizing the indirect trade utility function, derives...results in a manner that is both direct and at once intuitively transparent."

Demography↗
PubMed2003

Prevention of herpes simplex virus eye disease: a cost-effectiveness analysis.

OBJECTIVES: To estimate the cost of treating herpes simplex virus (HSV) eye disease, and to evaluate the incremental cost-effectiveness of chronic suppressive antiviral prophylaxis for reducing ocular HSV recurrences. METHODS: An economic decision-tree model was used on follow-up data from 703 patients with prior ocular HSV disease who were enrolled in a Herpetic Eye Disease Study multicenter clinical trial that evaluated the prolonged use of oral acyclovir. Costs were based on wholesale drug prices, Medicare fees, and national health surveys. Incremental cost-effectiveness ratios for all patients and for patients with prior stromal keratitis were calculated as the additional net cost of acyclovir prophylaxis compared with the number of cases of ocular herpes prevented during 12 months. One- and 2-way sensitivity analyses evaluated the effect of different treatment costs and recurrence risks. RESULTS: Approximately 17.7 US dollars million is expended annually to treat the estimated 59,000 new and recurrent episodes of HSV eye disease occurring among 29,000 individuals each year in the United States. Chronic suppressive oral acyclovir costs 8532 US dollars per ocular HSV episode averted. The incremental cost per infection averted would decline by up to 51% if antiviral prophylaxis were more effective and by up to 87% if patients had a higher recurrence risk. Targeting prophylaxis to patients with a history of stromal keratitis is not more cost-effective than providing oral acyclovir for patients with any prior HSV eye disease. CONCLUSIONS: Herpetic eye disease is costly to treat and prevent. Because prophylactic oral acyclovir is not a cost-effective option for all patients with previous HSV eye disease, therapeutic decisions must be made on a case-by-case basis.

Acyclovir↗